Healthcare Provider Details

I. General information

NPI: 1104331982
Provider Name (Legal Business Name): CHRISTOPHER LEE TROTTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 12/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 BLAZING TRAIL DR
COLORADO SPRINGS CO
80922-3032
US

IV. Provider business mailing address

6835 BLAZING TRAIL DR
COLORADO SPRINGS CO
80922-3032
US

V. Phone/Fax

Practice location:
  • Phone: 719-231-3436
  • Fax:
Mailing address:
  • Phone: 719-231-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: